Brainstem auditory evoked potential combined with high resolution cranial base CT can optimize the diagnosis of auditory nerve injury / 中华创伤杂志(英文版)

PURPOSE@#Auditory nerve injury is one of the most common nerve injury complications of skull base fractures. However, there is currently a lack of auxiliary examination methods for its direct diagnosis. The purpose of this study was to find a more efficient and accurate means of diagnosis for auditory nerve injury.@*METHODS@#Through retrospectively analyzing the results of brainstem auditory evoked potential (BAEP) and high-resolution CT (HRCT) in 37 patients with hearing impairment following trauma from January 1, 2018 to July 31, 2020, the role of the two inspection methods in the diagnosis of auditory nerve injury was studied. Inclusion criteria were patient had a clear history of trauma and unilateral hearing impairment after trauma; while exclusion criteria were: (1) severe patient with a Glasgow coma scale score ≤5 because these patients were classified as severe head injury and admitted to the intensive care unit, (2) patient in the subacute stage admitted 72 h after trauma, and (3) patient with prior hearing impairment before trauma. According to Goodman's classification of hearing impairment, the patients were divided into low/medium/severe injury groups. In addition, patients were divided into HRCT-positive and negative groups for further investigation with their BAEP results. The positive rates of BEAP for each group were observed, and the results were analyzed by Chi-square test (p < 0.05, regarded as statistical difference).@*RESULTS@#A total of 37 patients were included, including 21 males and 16 females. All of them were hospitalized patients with GCS score of 6-15 at the time of admission. The BAEP positive rate in the medium and severe injury group was 100%, which was significantly higher than that in the low injury group (27.27%) (p < 0.01). The rate of BEAP positivity was significantly higher in the HRCT-positive group (20/30, 66.7%) than in the HRCT-negative group (1/7, 14.3%) (p < 0.05). Twenty patients (54.05%) were both positive for BEAP and HRCT test, and considered to have auditory nerve damage. Six patients (16.22%) were both negative for BEAP and HRCT test, and 10 patients (27.03%) were BAEP-negative but HRCT-positive: all the 16 patients were considered as non-neurological injury. The rest 1 case (2.70%) was BAEP-positive but HRCT-negative, which we speculate may have auditory nerve concussion.@*CONCLUSION@#By way of BAEP combining with skull base HRCT, we may improve the accuracy of the diagnosis of auditory nerve injury. Such a diagnostic strategy may be beneficial to guiding treatment plans and evaluating prognosis.

Skull base aneurysms: a retrospective review of fifteen cases focusing on the involvement of internal carotid artery / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.

Anatomía radiológica de la base de cráneo y los nervios craneales parte 2: Nervios craneales / Skull base and cranial nerves radiologic anatomy part 2: Cranial nerves

Resumen: La anatomía de la base del cráneo es compleja. Numerosas estructuras neurovasculares vitales pasan a través de múltiples canales y agujeros ubicados en la base del cráneo. Con el avance de la tomografía computarizada (TC) y la resonancia magnética (RM), es posible la localización cada vez más precisa de lesiones y la evaluación de su relación con las estructuras neurovasculares adyacentes. El trayecto de los nervios craneales sigue un recorrido conocido y se transmiten a la cara y cuello por los forámenes de base de cráneo. La tomografía computada y la resonancia magnética son complementarias entre sí y, a menudo, se usan juntas para demostrar la extensión total de la enfermedad. La segunda parte de esta revisión se centra en el estudio radiológico de los nervios craneales.

Abstract: The skull base anatomy is complex. Many vital neurovascular structures course through the skull base canals and foramina. With the advancement of CT and MRI, the localization of lesions has become more precise as their relationship with adjacent neurovascular structures. There is a known course of the cranial nerves as well as their skull base exiting foramina to the head and neck. CT and MRI are complimentary modalities and are often used together to map the full extent of disease. The second article in this review focus on the radiologic study of the cranial nerves.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Lipoma intraóseo en la región esfenoclival: reporte de un caso y revisión de la literatura / Intraosseous lipoma in the sphenoclival region: case report and review of the literature

RESUMEN El lipoma intraóseo es un tumor mesenquimatoso poco frecuente que se presenta principalmente en el esqueleto apendicular. La localización dentro del cráneo, es aún más rara, y hasta la fecha solo se han descrito 6 casos en la literatura de lipomas intraóseos que comprometen la región esfenoclival. Por lo general, no presenta ningún síntoma y es un hallazgo incidental en el estudio de imágenes. Presentamos el caso de un paciente de 22 años de edad que consulta por obstrucción nasal y rinorrea mucosa de tres semanas de evolución. La tomografía computarizada y resonancia nuclear magnética evidenciaron una lesión en la región esfenoclival con características sugerentes de lipoma intraóseo. No se realiza estudio histopatológico. Con respecto al manejo, se decide hacer seguimiento radiológico. Se realizó una segunda resonancia magnética 4 meses después, sin cambios significativos.

ABSTRACT Intraosseous lipoma are a rare mesenchymal tumor that occurs primarily in the appendicular skeleton. Skull presentation is a rare finding, and only 6 cases have been described in literature so far of lipomas that compromise the sphenoclival region. In general, they are asymptomatic and occur as incidental findings in imaging studies. We present the case of a 22-year-old patient who consulted for nasal obstruction and mucous rhinorrhea of three weeks of evolution. Computed tomography and magnetic resonance imaging showed a lesion in the sphenoclival region suggestive of intraosseous lipoma. Histopathological study was not performed. Regarding management, radiological follow-up was decided. A second MRI was taken 4 months later, with no significant changes.

Anatomía radiológica de la base de cráneo y los nervios craneales parte 1: generalidades y base de cráneo / Skull base and cranial nerves radiologic anatomy part 1: basics and skull base

La anatomía de la base del cráneo es compleja. Numerosas estructuras neurovasculares vitales pasan a través de múltiples canales y formámenes de la base del cráneo. Con el avance de la tomografía computarizada (TC) y la resonancia magnética (RM) es posible la localización cada vez más precisa de lesiones y la evaluación de su relación con las estructuras neurovasculares adyacentes. El trayecto de los nervios craneales sigue un recorrido conocido y se transmiten a la cara y cuello a través de los forámenes de base de cráneo. La TC y la RM son complementarias entre sí y, a menudo, se usan en conjunto para demostrar la extensión completa de la enfermedad. La primera parte de esta revisión se centra en generalidades del estudio radiológico y anatomía de base de cráneo.

The skull base anatomy is complex. Many vital neurovascular structures course through the skull base canals and foramina. With the routine use of CT and MRI, the localization of lesions has become more precise as well as their relationship with adjacent neurovascular structures. There is a known anatomical course of the cranial nerves and their skull base s they course through the foramina towards the head and neck. CT and MRI are complimentary modalities and are often used together to map the full extent of disease. The first part of this review article series focus on the radiologic approach to disease and the skull base anatomy.

The intracranial and posterior cranial fossa volumes and volume fractions in children: a stereological study / Los volúmenes de la fosa craneal intracraneal y posterior y las fracciones de volumen en los niños: un estudio estereológico

SUMMARY: The size of intracranial cavity (IC) and posterior cranial fossa (PCF) plays an important role in the pathophysiology of various disorders. In this study, we aimed at establishing normal volume data of the IC and PCF in Turkish population according to age and sex by using stereological method. This study was carried out retrospectively on 339 individuals (168 females and 171 males) between 0 and 18 years old with no medical or neurological disorders that affected the skeletal morphology of the cranial cavity. Volumetric estimations were determined on computed tomography (CT) images using point-counting approach of stereological methods. Intracranial volume (ICV) and posterior cranial fossa volume (PCFV) were increased with age in both sexes. They reached adult dimensions at 5 years of age during the teenage years. According to sex; the mean ICV and PCFV were 1594.51±245.57cm3 and 244.89±53.86 cm3 in males, 1456.34±241.85 cm3 and 228.24±41.38 cm3 in females, respectively. Generally, significant differences were determined in ICV and PCFV according to sex after they reached maximum growth period. According to age the volume ratios of PCF to IC was ranged from 13.03 to 17.48 in males and 12.06 to 18.54 in females. This study demonstrated that these volume ratios could help the physician for both patient selections for surgery, and for the assessment of any surgical technique used to treatment of PCF malformations. However current study revealed that point counting method can produce accurate volume estimations and is effective in determining volume estimation of IC and PCF.

RESUMEN: El tamaño de la cavidad intracraneal (CI) y la fosa craneal posterior (FCP) desempeñan un papel importante en la fisiopatología de diversos trastornos. En este estudio, se pretende establecer los datos de volumen normal de la CI y FCP en la población turca, de acuerdo a la edad y el sexo, mediante el uso de métodos estereológicos. Este estudio se realizó retrospectivamente en 339 individuos (168 mujeres y 171 hombres) entre 0 y 18 años sin trastornos médicos o neurológicos que afectaron la morfología esquelética de la cavidad craneal. Las estimaciones volumétricas se determinaron en imágenes de tomografía computarizada (TC) utilizando el conteo de puntos de los métodos estereológicos. El volumen intracraneal (VIC) y el volumen posterior de la fosa craneal (VFCP) aumentaron con la edad en ambos sexos. Alcanzaron dimensiones adultas a los 5 años de edad durante la adolescencia. Según el sexo, el promedio de VIC y VFCP fue de 1594,51 ± 245,57 cm3 y de 244,89 ± 53,86 cm3 en los hombres, 1456,34 ± 241,85 cm3 y 228,24 ± 41,38 cm3 en las mujeres, respectivamente. En general, se determinaron diferencias significativas en VIC y VFCP de acuerdo con el sexo después de alcanzar el período de crecimiento máximo. Según la edad, las proporciones de volumen de FCP a CI oscilaban entre 13,03 a 17,48 en los hombres y 12,06 a 18,54 en las mujeres. Este estudio demostró que estas proporciones de volumen podrían ayudar al médico tanto en la selección de pacientes para la cirugía, como para la evaluación de cualquier técnica quirúrgica utilizada en el tratamiento de malformaciones de FCP. Además, el estudio actual reveló que el método de conteo de puntos puede producir estimaciones precisas de volumen siendo eficaz para determinar la estimación de volumen de IC y FCP.

Cranio-vertebral transition assessment by magnetic resonance imaging in a sample of a northeast Brazilian population / Avaliação da transição crânio-vertebral por ressonância magnética em uma amostra da população do nordeste brasileiro

ABSTRACT Platybasia and basilar invagination are important alterations of the cranial-vertebral transition. Neuroimaging-based platybasia parameters include the Welcker basal angle, distance between the apex of the odontoid and Chamberlain's line, and the clivus-canal angle. This study aimed to measure and correlate these parameters in a sample from northeast Brazil. Methods Cross-sectional analysis of craniometric parameters from individuals submitted to magnetic resonance at an outpatient imaging center between 2011 and 2012. Results Of 181 analyzed cases, the Welcker basal angle averaged 128.96º (SD 6.51), median distance between apex of the odontoid and Chamberlain's line was 2.27 mm (IQR -1.23-4.47) and the median clivus-canal angle was 150.5º (IQR 143.2-157.3). The Welcker basal angle was inversely correlated to the clivus-canal angle, and correlated to the distance between the apex of the odontoid and Chamberlain's line. Conclusion There was a tendency to platibasia, basilar invagination and narrowing of the cranio-vertebral transition.

RESUMO Platibasia e invaginação basilar são importantes alterações da transição craniovertebral. Existem parâmetros importantes obtidos pela neuroimagem, como o ângulo basal de Welcker, distância do ápice do odontoide à linha de Chamberlain e o ângulo clivo-canal. Este estudo procurou medir e correlacioná-los em uma amostra do Nordeste Brasileiro. Métodos Estudo transversal com medidas de indivíduos submetidos a ressonância magnética craniana em um centro de diagnóstico por imagem entre 2011 e 2012. Resultados Dos 181 casos analisados, o ângulo basal de Welcker teve média 128.96º (DP 6.51), a distância do ápice do odontoide à linha de Chamberlain obteve mediana 2.27 mm (IIQ -1.23-4.47) e o ângulo clivo-canal mediano foi 150.5º (IIQ 143.2-157.3). O ângulo basal de Welcker foi inversamente correlacionado com o ângulo clivo-canal e diretamente correlacionado com a distância do ápice do odontoide à linha de Chamberlain. Conclusão Houve uma tendência a platibasia, invaginação basilar e estreitamento da transição craniovertebral, que poderiam ser influenciados pela natureza multirracial e por fatores antropológicos da população estudada.

The morphometric analysis of the important bone structures on skull base in living individuals with multidetector computed tomography / Análisis morfométrico de las estructuras óseas importantes en base de cráneo de sujetos vivos mediante tomografía computarizada multidetector

In this study, it was aimed to determine the reliable morphometric data of the important bone structures on skull base using MDCT and to establish the differences of these data according to sex and lateralization. This study was retrospectively carried out on MDCT images in the Radiology Department of Meram Medical Faculty, Necmettin Erbakan University. We evaluated the images of the 100 (male 50 ­ female 50) adult subjects without cranial trauma, surgery, and any deformity of the bone. The height and anteroposterior diameter of the hypophysial fossa (HFheight, HFanteroposterior), the length of the occipital condylus, anterior and posterior intercondylar distances (OCn, AID, PID); sagittal diameter, transverse diameter and area of the foramen magnum (FMsgt, FMtrn, FMarea) were all measured. The statistical analysis was performed using the SPSS. The summary of the data was expressed as mean ± standard deviation. Student's t test was used to compare the male-female and right-left measurements. The relation betweeen parameters was evaluated by Pearson's correlation test. It was observed that right and left data in all parameters were higher in males than females. Higher values were usually determined on the right side in both sexes. In both sexes, some parameters were highly correlated (P<0.001). We believe that the results of this study may be useful for new surgical approaches and radiological assessment concerning skull base.

El objetivo de este estudio fue determinar datos morfométricos confiables de las estructuras óseas importantes de la base de cráneo mediante tomografía computarizada multidetector (TCMD) y establecer las diferencias de estos datos en función del sexo y lateralización. Se realizó un estudio retrospectivo a partir de imágenes de TCMD obtenidas en el Departamento de Radiología de la Facultad de Medicina Meram, Universidad de Necmettin Erbakan. Se evaluaron imágenes de 100 sujetos adultos (50 hombres y 50 mujeres), que no presentaban trauma craneal, cirugía o deformidad ósea. Se midieron (i) altura y diámetro anteroposterior de la fosa hipofisaria, (ii) longitud del cóndilo occipital y distancias intercondilares anterior y posterior, y (iii) el diámetro sagital, transversal y el área del foramen magno. El resumen de los datos se expresó como Media±DE. La comparación de los datos entre sexos y mediciones izquierda-derecha se realizó mediante la prueba t de Student, mientras que la relación entre los distintos parámetros mediante la prueba de correlación de Pearson. Todos los parámetros medidos, en el lado derecho e izquierdo, fueron mayores en hombres. Los valores más altos se determinaron generalmente en el lado derecho en ambos sexos. Algunos parámetros estuvieron altamente correlacionados en ambos sexos (P<0,001). Creemos que nuestros resultados pueden ser útiles al momento de realizar nuevos abordajes quirúrgicos y en la evaluación radiológica, relativas a la base de cráneo.

detection of eagle's syndrome with three-dimensional multidetector computerized tomography [CT]

Eagle's Syndrome is caused by elongation of the styloid process or ossification of the stylohyoid ligament. We aimed to evaluate the contribution of 3-Dimensional Multidetector CT findings on Eagle's syndrome. Three-Dimensional Multidetector CT were performed on 13 patients with Eagle's syndrome. Maximum intensity projection [MIP] and volume rendering [VR] images having optimal resolution in all patients were obtained using 3D reconstructions on work-station. Styloid process and its extension, and stylohyoid ligament were evaluated. A styloid processes e"3cm were accepted to be longer than normal. We also had a control group of patients which consisted of ten patients who had no complaints of dysphagia, throat pain, or foreign body sensation in the throat. Elongation of the styloid process was revealed by 3D VR imaging in all patients. We found elongated styloid process bilaterally in two patients. Elongation of the styloid process was clearly revealed by 3D VR imaging in high contrast and spatial resolution under the anatomic orientation like conventional X-ray in all patients. The diagnosis of Eagle's syndrome was confirmed surgically in four of 13 patients. We conclude that 3D VR imaging is a valuable diagnostic method in detecting elongated styloid process

Base de craneo: anatomia y patologia tumoral. revision conceptual / Skull base: anatomy and pathology tumoral conceptual review

Objective. Skull Base Tumors (SBT) span a spectrum from congenitallesions to malignant neoplasms The purpose of this study was to summarize the most relevant anatomical landmarks and to display and organize in a simple manner the SBT and perineural tumoral spread (PTS). Materials and methods. The study displays a selection of cases selected based on teaching value gathered by the author in the 1997-2002 period. Results. SBT can be classified in three main groups: 1-Intrinsic SBT: includes Chordoma, Chondrosarcoma, Meningioma, Neural Sheath Tumors and Metastasic Lesions. 2- SBT spreading from below: Includes Nasopharyngeal Carcinoma, Nasopharyngeal Juvenile Angiofibroma and Paranasal Sinus Tumors. 3-SBT from above: It is refers mainly to Pituitary gland macroadenoma. PTS occurs most commonly associated with adenoid cystic and squamous cell carcinomas originated at the Head and Neck region. Most commonly involves nV and nVII. The most important pathway of PTS through the Skull Base is the maxillary division of the trigeminal nerve (nV2). Conclusion. An adequate knowledge of the anatomy, pathology and spread patterns is an important tool for therapy planning and follow-up care.

Objetivo. Revisar la anatomía de la base de cráneo, sistematizar los tumores (TBC) que la afectan y analizar la diseminación perineural (DPN). Material y método. Revisión del archivo recolectado por los autores entre los años 1997-2002 y de casos publicados Resultados. Los TBC se pueden clasificar en: 1) Lesiones intrínsecas como el cordoma, condrosarcoma, meningioma, tumores de la vaina neural y metástasis. 2) TBC que parten desde abajo en los cuales se incluyen el carcinoma nasofaríngeo, el angiofibroma juvenil nasofaríngeo y tumores de los senos paranasales. 3) TBC que la comprometen desde sitios por sobre ella y que se refiere principalmente al macroadenoma hipofisiario. La DPN se observa asociada a tumores adenoideos quisticos y carcinomas de células escamosas originados en la región de cabeza y cuello. Compromete comúnmente nV y nVII. Las vías mas importantes de DPN es la división maxilar del nervio trigémino (nV2). Conclusión. Un adecuado conocimiento de la anatomía, patología y vías de diseminación es una importante herramienta en la planificación de la terapia y seguimiento de los TBC.

Atypical osteomyelitis of the skull Base

The authors reporetd six cases of atypical osteomyelitis of the skull base in diabetic patients. They were studied clinically, radiologically and pathologically. This disease may arise without intial temporal bone affection or may complicate incompletely treated malignant otitis externa. Spread of the disease may occur through vascular involvement of the skull bones and fascial planes rather than through the air cells. The ethmoid the sphenoid and occipital bones are affected beside the temporal bones and the petrous apex. Multiple cranial nerves may be affected including the 2nd, 3rd, 4th, 5th, 9th and 10th nerves and the disease may present as the jugular foramen or the orbital apex syndromes. The morbidity and the mortality of the disease is higher in patients without previous temporal bone affection because it is usually not promptly recognized and treated